Stand-alone percutaneous coronary intervention in Nigeria was performed with no mortalities, a 2.1% major adverse clinical event rate, and achieved complete revascularization in 60.4% of patients.
Cross-Sectional (n=80)
No
Is stand-alone percutaneous coronary intervention without surgical backup safe and effective in a Nigerian setting?
Stand-alone PCI without on-site surgical backup can be performed safely with low complication rates in a Nigerian setting, though complete revascularization rates may be limited by the lack of surgical backup for complex lesions.
BACKGROUND: There is a paucity of diagnostic and therapeutic facilities in Nigeria to confirm coronary artery disease and offer appropriate interventional therapy. There is now a private cardiac catheterization laboratory in Lagos but as there are no sustained Open Heart Surgery programmes, percutaneous coronary interventions are currently being performed without surgical backup. This study was designed to assess results of stand-alone percutaneous coronary intervention (PCI) as currently practiced in Lagos, Nigeria. METHODS: This cross-sectional study was conducted between July 2009 and July 2012. The study included all patients that underwent PCI in Lagos. Data was extracted from a prospectively maintained database. RESULTS: Coronary artery disease was confirmed in 80 (52.6%) of 152 Nigerians referred with a diagnosis of Ischaemic Heart Disease. There were 53 males (66.2%) and 27 females (33.8%). The average age was 60.3 +/-9.6 years and average euroscore was 4.5 +/-3.1. Of the 80 patients, 77 (96.3%) had significant stenoses and were candidates for revascularization. Distribution of significant stenoses was one in 32 patients (41.5%), two in 11 patients (14.3%), three in 19 patients (24.7%), four in 13 patients (16.9%) and five in 2 patients (2.6%). PCI was performed in 48 (62.3%) of the patients eligible for revascularization as the coronary anatomy in the remaining patients was not suitable for PCI. The indication for PCI was for myocardial infarction or unstable angina in 39 patients (81.2%). PCI was performed with PTCA plus stenting in 41 patients (85.4%) and with PTCA alone in 7 patients (14.6%) with good angiographic results. Overall 29 of the 48 patients (60.4%) had complete revascularization of significant stenoses. Complications of PCI were bleeding that required blood transfusion in 1 patient (2.1%), minor femoral haematomas in 2 patients (4.2%), and a major adverse clinical event in 1 patient (2.1%). CONCLUSION: A stand-alone PCI programme has been developed in Lagos, Nigeria. Both elective and urgent PCIs have been performed with no mortalities and a low complication rate. Increased volumes will however accrue and complete revascularization rates would be improved with the establishment of Open Heart Surgery programmes to provide CABG as back-up for PCI and alternate therapy for more complex lesions.
Johnson et al. (Thu,) conducted a cross-sectional in Coronary Artery Disease (n=80). Stand-alone Percutaneous Coronary Intervention (PCI) was evaluated on Complete revascularization rate. Stand-alone percutaneous coronary intervention in Nigeria was performed with no mortalities, a 2.1% major adverse clinical event rate, and achieved complete revascularization in 60.4% of patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: